It's easy to associate a pimply face with backpacks, braces, and Bieber fans—but things can get spotty later on too. Research from the University of Pennsylvania has found that low-grade, persistent acne is common among women in their twenties, thirties, and forties (yep, that magical time when wrinkles start to appear). While acne may be nonexistent or dormant for years, certain factors—like stress, hormones, and diet—can eventually cause it to surface, with frustrating emotional side effects. "I've seen patients shy away from certain situations—they've canceled dates and rescheduled meetings at work—because they're ashamed of their breakouts," says Joshua Zeichner, M.D., director of cosmetic and clinical research in the department of dermatology at Mount Sinai Medical Center in New York City. Because no woman should have to endure extra bumps in the road (or on her face), here's a simple zit-erasing plan.
BREAKOUT BASICS
When dirt, excess oil, and dead skin cells mingle, they plug the openings of your pores. This allows an army of Propionibacteria living in your sebaceous glands to set up camp, multiply, and create trouble for your skin. Although this pore-clogging process is the same whether you're 13 or 35, adult acne pops up in different places than the teen kind: "It typically appears on the jawline, chin, and neck, as opposed to the forehead, cheeks, and nose," says Zeichner.
Studies have traced the cause of acne to one thing: hormonal fluctuations. Whether brought on by lifestyle (stress, diet), PMS, pregnancy, or polycystic ovary syndrome (PCOS), the result is the same—an increase in cortisol (also known as the stress hormone), which gets broken down into testosterone, a male hormone that pumps excess oil through your pores. "When your hormones are out of whack, your skin's oil production may go into overdrive, causing an acne flare-up," says Zeichner.
And it doesn't take a midlife crisis for it to happen. "Even a moderate amount of daily stress—like balancing a career and a social life, or coming home from work and having to cook dinner for your family—is enough to trigger a breakout," says Ava Shamban, M.D., assistant clinical professor of dermatology at UCLA and author of Heal Your Skin. Smoking can also spark a breakout: A study in the Journal of the American Academy of Dermatology showed an association between lighting up and adult acne (specifically, whiteheads and blackheads) in women.
Given that the origin of acne goes deeper than your dermis, experts say that to nix blemishes, keeping your hormones in check is just as important as following the right skin-care regimen. Read on for ways to do it.
SEE SPOT FADE
Gone but not forgotten—zits often leave a lasting mark
Although post-inflammatory pigmentation—red spots that linger for months or even years after your pimples go away—is genetic, squeezing and picking can exacerbate the problem. "The earlier you treat the spots, the better the odds they'll disappear," says Francesca J. Fusco, M.D., assistant clinical professor of dermatology at Mount Sinai School of Medicine. Zeichner recommends applying a product containing the plant extract willowbark (a derivative of salicylic acid) and antioxidants (like vitamin C) twice a day to fade marks and boost cell turnover. Try StriVectin-EV Get Even Spot Repair ($49, strivectin.com). If your spots haven't ' budged after six months, consider getting chemical peels at your derm's office (they'll run you about $200 to $400 a pop); you might need two or three to get the job done.
PIMPLE-BUSTING PROTOCOL
1. STRESS LESS
First things first: Don't freak out if bumps show up; it'll only make things worse. Shamban recommends getting eight hours of sleep each night—it's how much you need to reduce excess cortisol and let your skin regenerate—and making time for stress-relieving activities like a 30-minute daily workout or even (yes!) sex to stay Zen. "These reduce excess cortisol and produce endorphins, which have a calming effect," she says. A bonus? Exercise delivers oxygen to your skin cells, making it hard for CVhating acne bacteria to thrive.
2. TREAT TOPICALLY
Though the same ingredients that clear up teen acne also work for the adult kind, grown-up skin is thinner and more prone to irritation—so you need a gentler, more moisturizing approach. "Using an acne wash, an acne lotion, and an anti-aging cream simultaneously may dry out the skin," says Fusco.
Start slowly: Wash your face twice a day with a salicylic acid cleanser to help dissolve dirt and oil and gently exfoliate the skin (if skin is on the dry side, cut back to once a day). Try (c) Origins Zero Oil Deep Pore Cleanser ($19.50, origins.com). If zits persist, cover them in a thin layer of a lotion with 0.5 to 2 percent salicylic acid at night Zeichner likes La Roche-Posay Effaclar K Daily Renovating Acne Treatment ($30, at drugstores). After two weeks—the amount of time it takes for your skin to get used to a new product—bump it up to twice a day. Got wrinkles too? Try a retinoid cream instead. "It smooths lines and speeds up the shedding of dead skin cells so they don't block pores," says Zeichner. Try RoC Multi Correxion Night Treatment ($26, at drugstores).
Either way, slather on SPF every morning, as zit fighters can make skin sun-sensitive. Try (f) Olay Professional Pro-X Clear UV Moisturizer SPF 15 ($30, at drugstores).
3. BE STARCH-SMART
High-glycemic-index (GI) carbohydrates like white bread and sugar-laden foods aren't just waistline saboteurs: "They raise blood sugar and insulin levels, another male-hormone-boosting process that may lead to breakouts," explains Glenn Kolansky, M.D., a dermatologist in Red Bank, New Jersey. Balance your hormones with low-GI eats-think whole grains and veggies—that won't aggravate acne. As for chocolate, despite past research that put the sweet stuff in the clear, a more recent study by the University of Miami Miller School of Medicine found that men who consumed six ounces of 100 percent pure cocoa daily got breakouts in a week. "It's likely that chocolate affects a woman's skin the same way," says Zeichner.
4. CONSIDER POPPING A PILL
If your pimples come out to play about a week before your period, your doctor may prescribe an oral contraceptive to help stabilize hormone levels throughout the month. "Birth control pills like Beyaz, Yaz, and Yasmin contain analog hormones that may help clear the skin," explains Shamban. (Or you can try spironolactone, a drug that may help nix breakouts and is available by prescription.) Birth control pills can also help women who overproduce male hormones, as in the case of PCOS (ask your doctor for a blood test if you have other hormone-related issues, such as an irregular cycle).
5. VISIT A DERM—STAT!
If you're plagued with deep, painful red bumps that just won't go away, schedule a doctor's appointment ASAP. "Cystic acne heals slowly and can leave permanent marks," says Zeichner. Your dermatologist will prescribe a topical retinoid (like Retin-A), antibiotic (to kill bacteria and reduce inflammation), or Aczone—an anti-acne, antiinflammatory gel that's great for those with sensitive or aging skin. Curious about Accutane? It works as a last resort for severe teen acne, but it won't combat the underlying hormonal issues of adult acne, and Zeichner says it "may come with unpleasant side effects," like depression, headaches, and thinning hair. Plus, you can't take it while pregnant—it can cause birth defects—or breastfeeding.
COMPLEXION CAMO
Concealer is supposed to mask problems, but applied the wrong way, it can actually magnify a zit. Los Angeles makeup artist Joanna Schlip explains how to hide your pimples.
1. Look for a matte or oil-free concealer
It will adhere better to the skin and won't slide off like a creamy formula can. One with sulfur also helps keep skin clear. Try Proactiv Solution Concealer Plus ($17, discoverproactiv.com).
2. Remember: Light shades enhance; dark ones recede
Never put a too-light concealer or shimmery powder onto a raised bump—it's like shining a spotlight on it. Match the concealer to your skin, then use a brush to lightly tap on a slightly darker matte eye shadow shade (like camel or taupe, depending on your skin tone) to give the illusion of a shrunken bump.
3. Layer
Think of a pimple as a tiny hill on your face. You need to apply a few thin layers to the blemish and the area around it to make the spot visually shrink. Use a concealer brush to pat it on (your fingers are a breeding ground for bacteria, which worsens acne) and blend well.